A preference to lie in the knee-chest position was associated with increased intracranial pressure (ICP) in three children, ages 12 and 20 months and 4 years, reported from the Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel. The forehead touched the floor on a level with the chest and knees, and the rest of the trunk was elevated so that the buttocks were uppermost. The 4-year old child had a mass in the pineal area, with obstructive hydrocephalus; the 20 month-old had pseudotumor cerebri that responded to acetazolamide and a return to a normal posture; the 12-month old had a cerebellar astrocytoma and obstructive hydrocephalus. The authors postulate that the knee-chest position favors a reduced pressure in the right heart atrium, thus augmenting the blood flow from the superior vena cava and dural sinuses. 
COMMENT. In infants and young children with brain tumors and few signs or subjective complaints, the knee-chest posture might be helpful in the clinical suspicion and diagnosis of increased intracranial pressure. This posture is also assumed by children with cyanotic heart disease and is a characteristic sign of acrodynia.